2016 MIPS Final Rule: What you need to know NOW
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Find out why you need to pay attention to this Final Rule and what adjustments you need to make to ensure you end up on the winning side of MIPS. It's a complicated program, and results from the Final Rule don't make it any easier.
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2016 MIPS Final Rule: What you need to know NOW
- 2. Submit by March 31, 2018 Feedback 2018 Adjustment January 1, 2019 The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) Quality Payment Program Timeline Performance Year 2017
- 3. Performance Period JANUARY 1 December 312017 The first performance period opens on January 1, 2017 and closes December 31, 2017
- 4. Support for small and independent practices New opportunities for Advanced Alternative Payment Models A flexible, pick-your- own-pace approach One unified program supporting Clinician-Driven Quality Improvement Changes in the Final Rule
- 5. • Less than or equal to $30,000 in Medicare Part B allowed charges • Less than or equal to 100 Medicare patients Small Practice Exclusion Small, independent practices will be excluded from new requirements if volume is:
- 6. What Is An Advanced Alternative Payment Model? Under the new law, Advanced APMs are the CMS Innovation Center models, Shared Savings Program tracks, or demonstrations where clinicians accept both risk and reward for providing coordinated, high quality, and efficient care. These models must also meet criteria for payment based on quality measurement and for the use of EHRs.
- 7. APM Path You earn a 5% incentive payment in 2019* * If you receive 25% of Medicare payments * If you see 20% of your Medicare patients through an Advanced APM in 2017
- 8. What is MIPS? • MACRA combines the existing Medicare Meaningful Use (MU), Physician Quality Reporting System (PQRS), and Value-Based Modifier (VBM) programs into MIPS, starting with the 2017 performance year. • MIPS payment adjustments are applied to Medicare Part B payments two years after the performance year, with 2019 being the payment adjustment year for the 2017 performance year. • MIPS defines four categories of eligible Provider performance, contributing to a MIPS composite performance score (CPS) of up to 100 points
- 9. Who is in the Quality Payment Program? You are a: Physician Physician Assistant Nurse Practioner Clinical Nurse Specialist Certified Registered Nurse Anesthetist you bill Medicare more than $30,000 a year and provide care for more than 100 Medicare patients a year If 2017 is your first year participating in Medicare, then you are not in the MIPS track of the Quality Payment Program.
- 10. Qualifying APM participant Partial qualifying APM participant Doesn’t meet the low volume threshold Who Is Exempt?
- 11. Pick Your Pace Don’t Participate -4% payment adjustment Submit Something 0% payment adjustment Submit a partial year +% payment adjustment Submit a full year +% payment adjustment
- 12. You Have Choices You can choose how you want to participate based on your: Practice size Specialty Location Patient population
- 13. ** Potentially up to 3 times these rates plus up to a 10% exceptional performance bonus ** Financial Impact Over Time Performance Year 2017 Medicare Part B Payment Adjustment Year 2019 +4% Incentive and -4% Penalty Performance Year 2018 Medicare Part B Payment Adjustment Year 2020 +5% Incentive and -5% Penalty Performance Year 2019 Medicare Part B Payment Adjustment Year 2021 +7% Incentive and -7% Penalty Performance Year 2020 Medicare Part B Payment Adjustment Year 2022 +9% Incentive and -9% Penalty
- 14. • CMS will set a threshold performance score each year based on all eligible provider scores from a prior period. • Scores exactly equal to the performance threshold = zero payment adjustment • Scores progressively above the performance threshold = progressively increasing incentives • Scores progressively below the performance threshold = progressively increasing penalties Every Point Counts
- 15. How is it scored? 4 performance categories Cost in 2017 0 points Advancing Care Information (formerly Meaningful Use) 25 points Clinical Practice Improvement Activities 15 points Quality (PQRS/VBM) 60 points
- 16. Quality Points Example If a PQRS measure has a 62% measure rate better than 60% of peers reflected in the benchmark, then that measure would earn 7 out of 10 possible points. Quality Points Example
- 17. CMS Quality Payment Program Website
- 18. What can I do now to prepare for January 2017? • Educate your organization as soon as possible • Estimate your MIPS score using your current MU, PQRS and VBM scores • Optimize MU & PQRS/VBM Quality to maximize the MIPS score • Evaluate staff, resources and organizational structure • Identify 2016 deadlines impacting 2017 MIPS, such as the Medicare Shared Savings Program Track 2/3 ACO or NCQA PCMH application deadlines to gain MIPS exemptions or points
- 20. Mining The Ability to Impact scale brings in clinical, social, and administrative factors to determine which patients are worth addressing Visualizing Package of preset graphs, heat maps, plots, and diagrams eases consumption of data Reporting Two Hour Guarantee - Sometimes you need an answer immediately Actions Key indicators automatically create actions Data Submission Quality programs require data submission - HEDIS • GPRO • Other quality measures CareOptimize Population Management Module
- 21. CareOptimize Care Management Module One Easy-to-Review Screen The CareOptimize Care Management module collects all relevant clinical information from disparate sources feeding the enterprise data warehouse and displays it on a single screen. • Automatically create evidence-based care plans specific to a patient’s • diseases and social impacts in seconds using the integration with M*Modal. • Review the evidenced-based literature included with the protocol, or simply override it on a per patient, per provider, or per organization basis. • Add your own protocols for your specific patient population. Routine contact with a Care Manager can be the difference between a stable patient or an expensive hospital stay. Medical assistants, health coaches, nurses, and physicians can proactively reach out to these patients and stop preventable expenses before they occur.
- 22. Identify. Assign. Engage. Measure. After your high-risk, high-cost, high-ability-to-impact patients have been identified, the cost improvements can have a dramatic increase on your bottom line.
- 23. CareOptimize Coding Module Make sure you are correctly reimbursed for the additional costs unhealthier patients incur • More precise diagnosis data • Supported clinical documentation in case of an audit • Greater efficiency, accuracy, and workflow management • Correct reimbursement • Discrete data from the EHR • Claims data from payer feeds • Scanned specialist notes • (neatly) Hand written notes Coding Accuracy Module More than 1,000,000 disease concepts developed over the past 15 years
- 24. Opportunities are identified overnight and available directly to physician at point of care Selected codes are automatically added to the encounter’s assessments within the EHR workflow Opportunities are reviewed and validated by coders before being sent on to the physician Rejected opportunities are continually reviewed Coding Opportunities
- 25. The CareOptimize Peer Benchmarking Module Automates registration for MIPS, MACRA, MU, PQRS, and VBPM Displays how peer organizations are scoring on measures, including which are topped out Recommends the best ways to maximize scores against your peers Automates the attestation process to CMS or Medicaid Gives real-time progress on CMS
- 26. How Can CareOptimize Help? • CareOptimize offers a State of the Practice Evaluation. This is a free evaluation that looks to see if your practice is running efficiently, checks to see if you are maximizing your reimbursements, and reviews the system to see if you are keeping up with Meaningful Use and all of the updated regulations. This evaluation also answers the question Are you ready for MIPS? • A CareOptimize project specialist will run your report, review it and go over it in detail with you to discover what you can be doing to make your practice even better.
- 27. State of the Practice Report • Top 20 Payers • Denial Rate • A/R Aging • Bill Lag Time • Charge Entry Lag Time • Unapplied Credits • Active Contracts • BBP Jobs List • Average Appointment per Day by Provider The State of the Practice Report captures information in these areas • First Third Appointment by Resource • Meaningful Use • CQM/PQRS by Provider • CCM Coding • All Users with Greater than 20 Tasks • All Users with Tasks Over 7 Days • All Templates in Use During the Last 2 Months • All KBM Templates in Use During the Last 2 Months • Referrals Open
- 28. Contact Us Please contact us to sign up for this free report today!! erica.badran@careoptimize.com Jonathan Shivers: 770-595-3096 jonathan.shivers@careoptimize.com Please follow http://www.ehrutilities.com/ to see additional utilities provided by CareOptimize.
- 29. CMS Additional Resources • CMS offers additional resources to help guide you through this final rule. https://qpp.cms.gov/education • Quality Payment Program Fact Sheet: https://qpp.cms.gov/docs/Quality_Payment_Program_ Overview_Fact_Sheet.pdf • Where to find Help: https://qpp.cms.gov/docs/QPP_Where_to_Go_for_Hel p.pdf • Comprehensive list of APMs: https://qpp.cms.gov/docs/QPP_Advanced_APMs_in_2 017.pdf
- 30. CMS Additional Resources (Continued) • CMS also offers Videos as well as Webinars. • The Quality Payment Program Service Center is also available to help. 1-866-288-8292 Monday-Friday 8:00am-8:00pm EST Questions can also be sent via email to QPP@cms.hhs.gov The new website CMS has created for this program can be accessed at https://qpp.cms.gov/